Probiotics are being increasingly studied for their ability to enhance host resistance to, and recovery from, infection. The probiotic strain Lactobacillus casei DN-114001 has previously been shown to reduce the incidence and duration of episodes of diarrhoea in children. Our controlled pilot study aimed to evaluate the effect of supplementation for 3 weeks with milk fermented with yoghurt cultures and L. casei DN-114001 on the incidence and severity of winter infections (gastrointestinal and respiratory) in elderly people. We found no difference in the incidence of winter infections between groups. However, duration of all pathologies was significantly lower in the treatment group (7.0 3.2 days, n=180) than in the control group (8.7 3.7 days; n=180) (p=0.024), as was maximal temperature (38.3 0.5 C treatment group vs. 38.5 0.6 C control; p=0.01). The potential for a 20% reduction in the duration of winter infections that we have found warrants further investigation on a larger scale.
Sarcopenia, the age-related loss of muscle mass [defined as appendicular LBM/Height2 (aLBM/ht2) below peak value by>1SD], strength and function, is a major contributing factor to frailty in the elderly. MK-0773 is a selective androgen receptor modulator designed to improve muscle function while minimizing effects on other tissues.
The primary objective of this study was to demonstrate an improvement in muscle strength and lean body mass (LBM) in sarcopenic frail elderly women treated with MK-0773 relative to placebo.
This was a randomized, double-blind, parallel-arm, placebo-controlled, multicenter, 6-month study. Participants were randomized in a 1:1 ratio to receive either MK-0773 50mg b.i.d. or placebo; all participants received Vitamin D and protein supplementation.
170 Women aged ≥65 with sarcopenia and moderate physical dysfunction.
Dual energy X-ray absorptiometry, muscle strength and power, physical performance measures.
Participants receiving MK-0773 showed a statistically significant increase in LBM from baseline at Month 6 vs. placebo (p<0.001). Participants receiving both MK-0773 and placebo showed a statistically significant increase in strength from baseline to Month 6, but the mean difference between the two groups was not significant (p=0.269). Both groups showed significant improvement from baseline at Month 6 in physical performance measures, but there were no statistically significant differences between participants receiving MK-0773 and placebo. A greater number of participants experienced elevated transaminases in the MK-0773 group vs. placebo, which resolved after discontinuation of study therapy. MK-0773 was generally well-tolerated with no evidence of androgenization.
The MK-0773-induced increase in LBM did not translate to improvement in strength or function vs. placebo. The improvement of strength and physical function in the placebo group could be at least partly attributed to protein and vitamin D supplementation.
This paper focuses on the role of insulin-like growth factor-1 (IGF-1) and its associated regulatory apparatus as a key endocrine, autocrine, and paracrine signalling system involved in mediating the anti-carcinogenic activity of dietary restriction. Literature is reviewed showing that the inhibitory action of dietary restriction on carcinogenesis is global and pervasive--it is effective in several laboratory species, for a variety of tumor types, and for both spontaneous tumors and tumors caused by different types of tumor-inducing agents. Evidence is presented showing the IGF-1 pathway responds appropriately to nutritional interventions including diet restriction. Recent evidence points to an obligatory role for the IGF-1 receptor in the establishment and maintenance of the transformed phenotype and reveals that IGF-1 in concert with insulin-like binding protein 3 and p53 is involved in autocrine/paracrine growth signaling pathways as adaptive responses to environmental stimuli. Considered together these works show that the IGF-1 pathway is uniquely poised to influence cellular transformation leading to the malignant phenotype by modulating the balance of cellular proliferation and cell death (apoptosis) in precancerous and cancerous cells and by influencing metastasis of nascent tumors. We evaluated these hypotheses directly using animal models of mononuclear cell leukemia, bladder transitional cell carcinogenesis, and breast cancer. Our studies demonstrate that manipulation of IGF-1 level through dietary intervention influences tumor growth and metastasis. Upregulation of this pathway demonstrated that increased IGF-1 stimulates tumor proliferation, progression and metastasis. Conversely, downregulation of this pathway in vivo as a consequence of dietary restriction results in antitumorigenic activity. We found that the functional disruption of IGF-1R markedly influences breast cancer metastasis in nude mice by suppressing cellular adhesion, invasion, and metastasis of breast cancer cells to the lung, lymph nodes, and lymph vessels. Epidemiological observations and clinical oncology results support the involvement of IGF-1 in carcinogenesis and anticarcinogenesis. This leads to the hypothesis that factors such as IGF-1 which regulate body size and composition may be related to human cancer incidence or prognosis. Additional understanding of this pathway and its interactions with other signaling pathways will advance our ability to develop new interventions towards decreased cancer risk in humans.
To evaluate the effect of oral nutritional supplementation with and without oligosaccharides on gut bacteriology, in particular the bifidogenic flora, and on immunology and inflammatory parameters in older persons at risk of malnutrition.
Prospective, randomized, double-blind, controlled study.
Division of Geriatric Medicine, St. Louis University, Missouri, United States. Participants: Seventy-four community dwelling elderly and/or nursing home subjects (age superior 70 y; 84 +/- 7 years) either undernourished or at risk of undernutrition. Intervention: Daily liquid supplements, with (1.3 g/250 ml) and without oligosaccharides (OS) for 12 weeks.
Nutritional evaluation, serum immunoglobulins, lymphocyte subsets, various cytokines and the endotoxin soluble receptor CD14 (sCD14) in serum, and cytokines specific mRNA in peripheral blood mononuclear cells at baseline and 12 weeks, and fecal bacteriologicy.
Specific mRNA extracted from blood leucocytes showed a different level of pro-inflammatory gene activation: TNF-alpha mRNA and IL-6 mRNA diminished in the OS group after 12 weeks, while no changes were detected in the control group (P=0.05 and P=0.04 respectively). Serum levels of sCD14, a product shed by activated macrophages, decreased only in the OS group without reaching statistical significance (P=0.08). No significant differences were detected in the fecal gut flora or in the nutritional parameters.
This study shows that the administration of supplements in older persons at risk of malnutrition may benefit from the addition of prebiotics that can improve the low noise inflammatory process frequently observed in this population.
To describe the design anf baseline patient characteristics of a multicomponent specific care and assistance plan (PLASA) study in Alzheimer's Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily looking at change in functional capacity.
Two-years prospective cluster randomized controlled trial comparing PLASA and usual care.
Forty-nine hospitals in France.
1120 community-dwelling AD.
Patients in the intervention group are evaluated biannually using a standardized comprehensive global assessment. In the case of decline in any one domain a standardized study protocol recommends specific physician directed intervention in addition to information and training for the caregiver.
Alzheimer Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in Dementia scale, Clinical Global Impression of Change.
At baseline, the two groups were similar regarding patient and caregiver characteristics. The mean patient age was 79.61+5.72 years and the mean MMSE 19.73+4.01 for the whole cohort. Time since dementia diagnosis was about 1.37+1.65 years in the whole cohort. Almost a third of the patients lived alone at baseline. Mean monthly time spent in caregiving in the whole cohort was 52.70+71.83 hours for instrumental activities and 17.73+51.38 hours for basic activities.
Persons with dementia suffer different losses at different stages of the disease and therefore accurate assessment of abilities and losses is critical to assist the person in planning for their future and for care needs. The PLASA intervention study is ongoing with 2 year follow-up to be completed in 2007.
The nutritional status of older persons suffering from various medical or surgical conditions has been well reported. However, studies focusing on hematology patients are very rare.
Our aim was to obtain a photographic picture of the nutritional profile of a sample population treated for miscellaneous blood disorders, to compare our results with those obtained in other types of diseases and to isolate risk-factors for undernutrition.
One hundred-twenty free living hematology patients aged over 60-year were prospectively and randomly tested the day of their admission to either our out- or inpatient clinic (department of clinical hematology from a French general hospital) using the mininutritional assessment (MNA). We compared our data with those from the literature and the role of various risk-factors was evaluated using the chi-square or the Fisher exact test.
The sex ratio was 1 and the median age 74 (range: 60-97). The majority of this population suffered from malignant disorders (101 cases, 84%) and fifty-three of them received chemotherapy. Eighty individuals (66%) were tested at the outpatient unit. The mean MNA score was 22.8 (range: 7.5-30). Sixteen patients (13%) were categorized as in poor nutritional status (MNA< 17). In this subgroup, more than 3 drugs intake (p < 0.01) and recent weight loss (p = 0.015) were the most important MNA parameters predicting malnutrition (age, sex, disease type or duration being no significant risk-factors). Our MNA results compared favorably with those obtained in other medical or surgical specialties.
Undernutrition does not appear more prevalent in the elderly hematology population in comparison with patients suffering from other diseases. However, because nutritional status may influence the outcome, especially in case of blood neoplasms, MNA (or other more sophisticated biological tools) should be included in the evaluation of this population.
To present results from a two year prospective study on diet, 6 months before and 18 months after retirement. The studied population exhibited an increase in social and physical activities over time after retirement. A significant decrease in weight was found in men 18 months after retirement. Retired individuals reported taking more time for breakfast. 45.5% of retired individuals, compared to 25.5% before retirement, took more than 30 minutes for lunch than before retirement. The amount of dietary nutrients consumed remained the same before and after retirement. However, retired individuals ate out more often, and had guests more frequently. Nutrients' distribution is similar before and after retirement. Given a life expectancy of more than 20 years after retirement, it is necessary to initiate nutritional intervention.
Clinical trials in Alzheimer's disease (AD) include patients benefiting from recent improvements in AD management.
To observe the progression of Alzheimer's disease (AD) after 6 and 18 months in patients treated with acetylcholinesterase inhibitors (AChEI) in order to determine the best duration of follow-up necessary to demonstrate the impact of new drugs.
Six hundred and eleven patients included in the REAL.FR cohort were treated with AChEI at baseline. We describe the cognitive, functional, behavioural, nutritional and global changes in the 509 and 364 patients who completed 6 and 18 months of follow-up, respectively, and who did not discontinue treatment.
After 6 and 18 months, we observed a statistically significant change in the MMSE (-0.54 +/- 3.13 at 6 months and -2.90 +/- 4.10 at 18 months), ADAS-cog (1.58 +/- 5.23 and 4.02 +/- 6.83), ADL (-0.30 +/- 0.79 and -0.84 +/- 1.20), IADL (-0.31 +/- 0.95 and -0.94 +/- 1.20), CDR sum of boxes (0.75 +/- 2.03 and 2.65 +/- 3.18) and MNA scores (-0.42 +/- 2.89 and -0.95 +/- 3.57), demonstrating the progression of AD. But on examining these changes, it appears that even if they were statistically significant at 6 months, they do not appear to be clinically relevant or sufficient to allow the observation of the effect of a new drug at this time, whereas such observation would be possible after 18 months. Similar results were obtained in a subgroup of patients who answer to the inclusion criteria of disease modifying trials which confirms the need for having 18 months of follow-up.
Changes in AD in patients under AChEI treatment are not sufficient to demonstrate the effect of a new treatment at 6 months. However, 18-month trials appear to have the potential to demonstrate clearly the effect of a new drug.
Evaluate the impact of the Geriatric Oncology Consultation on the final therapeutic management of cancer in elderly patients aged 70 and older.
The Pilot Coordination Unit in Geriatric Oncology of Côte d'Or, Burgundy, France.
From January 2010 to December 2010, 191 patients with cancer aged 70 and older.
The concordance between the treatments proposed following the Tumor Board, those proposed following the Geriatric Evaluation (GE) and those actually given to the patients was evaluated using the Kappa agreement test.
One hundred and ninety-one patients were included. Mean age was 81.5. The most frequent cancer locations were breast (31.9%), colon-rectum (14.1%) and lung (10.5%). Concordance between the cancer treatments proposed by the Tumor Board and those suggested after the GE was excellent except for chemotherapy and targeted therapy, which were recommended less frequently by the geriatrician (Kappa = 0.67), and support care, which was more often proposed after the GE (Kappa = 0.61). However, concordance between treatments proposed by the geriatrician and treatment actually given was not so good for chemotherapy (Kappa = 0.58), and surgery (Kappa = 0.61), since both were often replaced by a less aggressive treatment.
Concordance between the therapies proposed during the Tumor Board or after the Geriatric Oncology Consultation and the treatment actually given was satisfactory. However, the role of the oncologist remains determinant in the final choice, especially for chemotherapy.
Quality control including validation in dietary surveys is needed to reduce and detect errors which would lead to an attenuated scientific foundation for the diet-disease relationship. Especially studies in the elderly are needed because of limited knowledge of reference values, cut-off values etc.
To validate a modified dietary history method (the SENECA-method) in elderly subjects.
A survey of Danish men and women aged 80 years, who participated in the 1914-population study in Glostrup.
A pilot study (n = 34) validated the dietary history against 24-h urine collections; a main study (n = 240) compared dietary history with a 3-day estimated food record.
Protein intake from dietary history was 10% higher than calculated protein intake from 24-h urine collections. Differences in intakes of energy and macronutrients between dietary history and 3-day food record were generally small and non-significant, and there was good agreement between the methods in classifying nutrient intakes into same tertiles. A Bland & Altman plot indicated increasing differences in energy intake between methods with increased energy intake. Evidence for under-reporting of energy intake and/or over-reporting of the physical activity level was further made plausible when physical activity ratio was compared to recognized cut-off limits.
The modified dietary history method can be used to estimate dietary intake in 80 year old subjects, but some degree of misreporting, especially under-reporting, appears to be present. Keeping this in mind it is, however, possible to analyse dietary intake against other survey data.
This paper describes the Finnish experience on the population strategy to prevent cardiovascular disease with special reference to diet. Systematic work to lower the risk factors of cardiovascular disease started in the early 1970s with the North Karelia project and rapidly expanded to cover the whole country. The main aims were to change the type of fats used, to lower sodium intake and to increase vegetable and fruit consumption. Concurrently, a comprehensive monitoring system was developed including regular population surveys every five years. During the period 1972-1997 major changes took place in the diet as well as in blood pressure and serum cholesterol levels. At the same time, cardiovascular mortality decreased dramatically. The Finnish experience shows that dietary changes are possible but require a persistent and comprehensive intervention.
We examined trends from 1977-2010 in calorie, macronutrient, and food group intake among US adults 55 and older.
Cross-sectional time series.
A nationally representative sample of the US non-institutionalized population.
Older Americans aged ≥55 years (n=18,603) from four surveys of dietary intake in 1977-1978, 1989-1991, 1994-1996, and 2005-2010.
Dietary intake was assessed using one 24-hour recall. Multivariable linear regression models were used to determine adjusted per capita mean energy and macronutrient intake for each survey year. Interactions were used to examine differences by race/ethnicity, gender, and generation. The top five food group contributors to total calorie intake were identified for each year.
Mean total calorie intake increased significantly among older Americans from 1977-2010. Increases in carbohydrate intake (43% to 49% of total calories) were coupled with decreases in total fat intake (from 40% to 34%) while saturated fat (11%) remained constant. Corresponding shifts in food group intake were observed, as red meat intake greatly declined while bread and grain desserts became dominant calorie sources. Calorie intake was significantly higher for whites compared to blacks from 1994-2010. Cohort analysis indicated a shift from decreasing caloric intake with age to relatively stable calorie intake despite increasing age in more recent cohorts.
Increases in total calorie intake from 1977-2010, coupled with the finding that more recent generations did not show the expected age-related decrease in caloric consumption, raise concerns about obesity risk among older Americans. Additionally, despite declines across time in total fat intake, saturated fat intake continues to exceed recommendations, and shifts toward increased consumption of grain-based desserts suggest that high discretionary calorie intake by older Americans might make it difficult to meet nutrient requirements while staying within energy needs.
In 1979, Dr. James S. Goodwin, M.D., assisted by Philip J. Garry, Ph.D., submitted a grant proposal to the United States Public Health Service/ National Institute on Aging (NIA) entitled, "A prospective study of nutrition in the elderly". This study was approved and funded by the NIA beginning in 1979. Initially, approximately 300 men and women over 65 years of age with no known medical illnesses and no prescription medications were selected for this study. The primary purpose of this multi disciplinary study, known in the literature as the New Mexico Aging Process Study (NMAPS), was to examine the role of nutrition and resultant changes in body composition and organ function in relation to the aging process and health status of the elderly. This was accomplished by following prospectively healthy elderly volunteers, obtaining in-depth information about dietary habits, lifestyle, body composition, organ function, cognitive status, vitamin metabolism, genetic markers, and biochemical measures of nutritional status and then examining these data in relationship to age and health status and changes in health status. Some of the specific aims of the study were modified over the course of this longitudinal study because of availability of University of New Mexico School of Medicine faculty with expertise in different areas of aging research. In 1988, Dr. Bruno Vellas from the University Hospital in Toulouse, France became an on-going visiting professor at the University of New Mexico School of Medicine. From 1988, until the study was terminated in 2003, Dr. Vellas has collaborated with the faculty involved in the NMAPS on a number of research projects. In this article, we provide information about the studies overall design and briefly describe some of the major finding of the NMAPS.
To assess longitudinal changes in subjective and objective measures of physical performance in elderly Europeans.
Longitudinal study including SENECA measurements 1993-1999.
Data were collected in 9 'traditional' European towns.
In total 444 men and women, born 1913-1918 participated both in the follow-up survey in 1993 and in the finale in 1999. Changes in Activities of Daily Living (ADL), the 7 item Physical Performance Test (PPT) and in the ability to perform the chair stand and the tandem test were measured.
ADL and PPT did not change significantly between the 2 surveys, while participants needed more time to perform the chair stand (p<0.02) and their balance declined according to the tandem test (p< 0.01). Men were significantly better than women, in all measures of physical performance. However, the decline in functioning was of the same magnitude. All tests showed significant variation between centres in physical function. Significant cross cultural variation was found for changes in the capacity to perform the objective tests. Tests of distributions showed good association between the self reported and objective measures of physical performance. Rather than assessing the same task in several ways, the measures may reflect different levels of disability, and as such be important end point measures.
Both ADL and objective tests of simple functions applied well in the SENECA population. Physical performance declines with age. Across European towns variation in physical performance was identified.
The purpose of this article is to alert readers of this issue to the ongoing National Diet and Nutrition Survey series in mainland Britain, and to draw attention to the existence of information on the use of dietary supplements by different age-groups in the UK, and to some specific issues which need to be addressed, in order to achieve reliable estimates of supplement use from surveys of this type.
To determine the proportion of Australian adults >65 years with nutrient intakes less than 70% of the current national RDIs and investigate associated differences in both diet quality and quantity.
Intake data were collected as part of the National Nutrition Survey 1995 representing all areas of Australia. Dietary intake of 1960 (902 males) adults >65 years was assessed using a structured 24-hour diet recall. Intakes of 12 micronutrients were compared with current Australian recommended dietary intakes (RDIs) and assessed as > RDI, < RDI but > 70% RDI, and < 70% RDI.
Intakes of vitamin A, magnesium, potassium and calcium were < 70% RDI in 12-24% males and 14-61% females. In addition 10% and 43% females had low intakes of folate and zinc respectively. None of the participants had intakes of niacin or vitamin C < 70% RDI, and few males had low thiamin intakes. Specific nutrient density and energy intake (kJ/kg) were significantly less in those with intakes < 70% RDI for eight of the 12 nutrients studied.
In general the low nutrient intakes reported here can be attributed to diets of poor quality, in terms of low nutrient density, and quantity of food eaten. Age-specific targeted nutrition promotion strategies are required to improve overall health of older Australians.
The European Academy for Medicine of Ageing, founded by professors in geriatric medicine, provides a geriatric education program for European postgraduate physicians in geriatric medicine who are future academics in geriatric medicine in their countries. The course is organized for 30 participants involved in four one week residential sessions over two years. The program of each session involves 20 teachers, and includes state of the art lectures, student's lectures and working-group discussions. A first course took place in 1995-96, a second in 1997-98, a third has been accomplished in 1999-00, a fourth for 2001-02 and a fifth is ongoing for 2003--2004. The sessions are subjected to an evaluation program regarding the skills of the students, the value of the presentations and the satisfaction about the educational activities. The evaluations of the four sessions of EAMA course II (1997-1998) are presented here, with emphasis on the changes across the sessions for the whole group and for the individual students. The results are good to excellent for the main goals of the course, both by self-evaluation and by peer-evaluation. The dynamic process of this European academic-oriented geriatric education program attracts an increasing number of participants seeking the necessary skills and expertise to obtain academic position in geriatrics, and to meet international colleagues for further collaborative opportunities. Changes and adaptations of the following programs are fostered by the evaluation program to enhance weaker points. Accordingly, improvements in the programs and in the evaluation methods have been introduced during the third course, and are tested during the fourth and the fifth course.
To examine and compare the prevalence of use of vitamins, minerals, and fish-oil products (VMFO) in Finnish community-dwelling older people at two time points over a decade, and to explore the associated factors with the VMFO use.
A postal survey was sent to people aged 75, 80, 85, 90, and 95 years living in Helsinki, Finland in 1999 (N=3219) and in 2009 (N=2247). The response rates were 78% (n=2511) and 73% (n=1637), respectively. The surveys included items on demographic and health related factors, used medication and self-reported supplemental use of vitamins or minerals, and natural products.
The proportion of respondents using at least one VMFO was 49.8% in 1999 and 66.8% in 2009 (p<0.001). The proportion using vitamin D (RR 4.58, 95% CI 3.89 to 5.40; p<0.001), calcium (RR 2.47, 95% CI 2.18 to 2.80; p<0.001), magnesium (RR 1.47, 95% CI 1.17 to 1.85; p<0.001), and fish-oil/omega3 products (RR 3.66, 95% CI 2.41 to 5.55; <0.001) was higher in 2009 than in 1999, even when adjusted for age, gender, living conditions, education and comorbidities, whereas that of other vitamins and fish-liver-oil products was lower. At both time points the use of VMFO was associated with female gender and higher number of used medications. In 1999, higher education was associated with VMFO-use while age and comorbidities was not. In 2009 higher age and comorbidities was associated with VMFO-use.
The use of VMFO is common among community-dwelling older people and it has significantly increased over ten years. The increase was mainly due to the use of vitamin D and calcium. The consumption of other vitamin supplements has decreased. Education was no longer associated with use of VFMO in 2009 where as age and comorbidities were.
This paper describes health related quality of life in 81-85 year old participants of the SENECA study and relates outcome to health and physical performance.
SENECA is a mixed-longitudinal study in birth-cohorts, 1913-1918, with baseline measurements in 1988/1989 repeated in 1993 and 1999. Nine towns collected data in 1999. The study population consisted of 445 survivors.
Health related quality of Life was measured by The Nottingham Health Profile (NHP). Percentages of answers (yes/no) to 38 items were used for scoring different dimensions. Self-perceived health was measured by a global question with five answer categories and chronic diseases as presence or absence of any chronic reported disease. For functional ability, a standardised Activity of Daily Living (ADL) questionnaire was used with 16 questions on a 4-point scale. Functional limitations were measured by a sum-score of objective simple functions tests (PPT).
Average scores in the different sections were: Energy:46, pain:55, emotional reactions:58, sleep:64, social integration:47 and physical mobility:70 11% had no problems in any of the sections. All health and physical performance measures were significantly associated with, not only physical mobility, but also affective and social components of quality of life, age 81-85.
The Nottingham Health Profile was a useful instrument to measure health related quality of life in physical, affective and social dimensions across birth cohorts, gender and culturally different towns in Europe. The answers apparently mirrored the subjective disadvantage of impairment-related functional limitations and may therefore be used as end point for further analyses of SENECA data.
To determine the association between anthropometric indicators of adiposity with type 2 diabetes mellitus (T2DM) and hypertension (HTN) in older adults.
Cross-sectional study of participants of the Mexican Health Survey 2000 (MHS).
Mexico, subjects recruited from the general community.
The analytic sample included 7,322 adults who were > or = 60 years of age at the time of the survey. T2DM data were available on 6,994 individuals, who represent 95.5% of the original sample; data on HTN was available on 6,268 subjects, which accounted for 86.5% of the original sample.
Type 2 diabetes mellitus and hypertension, as well as anthropometric indicators including body mass index (BMI), waist circumference (WC), and conicity index (CI).
The prevalence of T2DM and HTN in this age group was 34.3% and 73.9%, respectively. After adjusting for other variables, the association between high WC and T2DM (OR = 1.59 95%CI = 1.26-2.01, P < 0.001) was stronger than the association with overweight (OR = 1.26, 95%CI = 1.01-1.58, P = 0.04) and obesity (OR = 1.38, 95%CI = 1.08-1.79, P < 0.01) using BMI, and slightly higher than tertile 2 of the CI (OR = 1.49, 95%CI = 1.20-1.88, P < 0.01), while tertile 3 showed a stronger association with T2DM (OR = 1.60, 95%CI = 1.22-2.08, P < 0.001). However, the association between obesity and HTN measured by BMI (OR = 1.98, 95%CI = 1.48-2.65, P < 0.001) was stronger than what was observed with overweight (OR = 1.42, 95%CI 1.13-1.77, P < 0.01), with high WC (OR = 1.62, 95%CI = 1.25-2.10, P < 0.001) and tertiles 2 and 3 of the CI (OR = 1.23, 95%CI = 0.99-1.55, P = 0.09); (OR = 1.53, 95%CI = 1.16-2.03, P < 0.01) respectively.
BMI and abdominal obesity are significantly and independently associated with an increase in the prevalence of T2DM and HTN among older Mexican adults.
Malnutrition occurs frequently in the elderly and is correlated with decreased functionality and thereby quality of life, as well as increased morbidity and mortality. This holds true for elderly people living in the community, patients in acute-care hospitals, as well as residents in long-term care facilities. To diagnose malnutrition, it is crucial to have sensitive, easy-to-use and specific tools at hand. The focus of this article is to compare strengths and weaknesses of the most commonly used assessment tools for malnutrition in the elderly, Malnutrition Universal Screening Tool (MUST), Mini Nutrition Assessment (MNA), Subjective Global Assessment (SGA), and Nutrition Risk Screening (NRS 2002). In conclusion, 15 years after its introduction, the Mini Nutritional Assessment (MNA), which was especially developed for elderly people, remains the gold-standard for ambulatory living elderly and those living in long-term care facilities, whereas the NRS 2002 has especially good potential in the acute-care setting, as it was developed specifically for hospitalized patients who need nutritional support.
To examine the associations among health behaviors, healthy body weight, and use of preventive services of adults 65 years and older using the 2007 Behavioral Risk Factor Surveillance System (BRFSS) as a function of caregiving status.
Participants (N=6,138) residing in the states of Hawaii, Kansas, and Washington completed questions about caregiving. We examined if there were any associations among body weight--having a healthy weight (body mass index 18.5-24.9 kg/m2); modifiable health behaviors--not smoking, consuming < or = 1 alcoholic beverage per day, consuming at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week; and using preventive services--receiving an annual influenza immunization, and ever receiving a pneumococcal immunization.
The two groups did not differ significantly on the modifiable health behaviors of fruit and vegetable consumption, smoking status, or alcohol consumption, or having a healthy weight. Caregivers were significantly more likely to meet physical activity recommendations than non-caregivers (54.1%, 42.0%, respectively, p < 0.001). No significant differences were found between caregivers and non-caregivers on receiving influenza and pneumococcal immunization.
Older adults who are caregivers are more likely than other older adults to meet government recommendations for physical activity; however, they have similar patterns of engaging in other health behaviors, including health eating and use of preventive services.
Background and aims:
Sarcopenia, the loss of skeletal muscle mass and strength, develops with aging and may be a pivotal risk factor in individual cardiovascular diseases (CVDs). We examined whether sarcopenia was positively associated with the prevalence of CVDs, including angina pectoris, myocardial infarction, and stroke, in adults of each gender aged ≥50 years, independent of other covariates and possible confounders.
Methods and results:
This cross-sectional study included 3,009 men and 4,199 women aged ≥550 years who participated in the 2008-2010 Korean National Health and Nutrition Examination Survey. Sarcopenia was defined as appendicular skeletal muscle mass/body weight <1 (moderate) or 2 (severe) standard deviations below gender-specific means for young adults. CVD prevalence was positively associated with sarcopenia in men after adjusting for confounders involved in CVD risk factors (Class I, OR=1.847 and Class II, OR=2.347; P<0.05). However, no such association was found in women. Furthermore, for individual CVDs, a strong positive association between stroke and sarcopenia (Class I, OR=1.734 and Class II, OR=3.725; P<0.05) and a moderate association between angina pectoris and sarcopenia (Class I, OR=1.988 and Class II, OR=1.347; P<0.05) were observed in men only. Interestingly, only the estimated homeostasis model assessment of insulin resistance was greater in men with moderate and severe sarcopenia than in those with normal states, whereas only serum total cholesterol levels were significantly higher in women with severe sarcopenia than in those with normal states. In both genders, serum 25-hydroxyvitamin D levels were significantly lower in moderate and severe sarcopenic states.
men aged ≥50 years with sarcopenia showed elevated prevalence of CVDs, especially stroke, in a representative sample of the general South Korean population.
After the submission of 520 symposiums, the IAGG PARIS 2009 scientific committee received 4390 submissions for oral and poster communications. The web site closed after the deadline. A late breaking news call will be opened between April 15th and April 30th, 2009 giving the opportunity to present new data from recent findings. For biological sciences, 163 submitted communications are focused on mechanisms of ageing. With regards to geriatric medicine, 591 communications are on frailty, osteoporosis, sarcopenia, 335 on Alzheimer's disease, 239 on vascular diseases, 229 on nutrition, 85 on nursing homes. Concerning psychological and behavioural sciences, 285 submitted communications are related to psychological aspects of ageing and 81 on behavioural disorders. For social gerontology, 257 concern integrated models of care and 278 concern social welfare and policy. Fourty-seven percent of the submitted communications are from Europe, 16% from North America, 15% from Asia and 12% from South America. In the country by country figures, it appears that 602 abstracts were submitted from France, 431 from Brazil, 371 from Canada, 318 from USA, 267 from UK, 237 from Australia, 214 from Japan, 185 from Spain, 142 from Germany and 123 from Italy. A total of 91 countries are represented. A simultaneous translation will be provided in one of the lecture rooms. As we can see Gerontology is growing all around the world. 4390 proposals for communications and more than 500 proposals for symposiums were submitted to the Paris 2009 world congress. It is certainly the demonstration of the large development of our specialty. With so many presentations, we have a unique opportunity to build a very attractive program where new findings from important research will be featured. Such increasing activity is due to the development of issues like Alzheimer's disease, sarcopenia, frailty... each having basic clinical, psychological and social aspects. The challenge: set up global expertise. It is our hope that the IAGG world congress will contribute to making Gerontology a major discipline. It will be not our success but your success.
Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate.
The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons.
Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG).
Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice.
Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.
Despite negative topline phase 3 clinical trial results for bapineuzumab and solanezumab in mild to moderate AD, findings from these trials and recent advances suggest renewed optimism for anti-amyloid therapies. Aβ immunotherapy has now demonstrated its ability to engage CNS Aβ and modify downstream CNS biomarkers in bapineuzumab treated patients, and to show likely cognitive benefits in mild patients treated with solanezumab. The current availability of potent BACE inhibitors provides additional opportunities to test the value of reducing Aβ in the clinic. Trial enhancements, such as selecting and enriching for early stage AD, treating participants longer and using more sensitive composite endpoints may further improve our chances of demonstrating clinical efficacy and securing beneficial treatments for patients.
To assess the validity of the Mini Nutritional Assessment-Short Form (MNA-SF) in elderly patients from the Toulouse Frailty Platform.
Overall, 267 patients aged 65 and over, without severe cognitive impairment (i.e. Mini Mental Status Examination > 20 and CDR<1), no physical disability (i.e. Activities of Daily Living ≥ 5) and no active cancer history (over the past 12 months) were included in 2013.
Receiver operating characteristic (ROC) analyses were used to assess the predictive validity of the French version of the MNA-SF for good nutritional status (defined as a full MNA score≥24/30). Analyses were conducted in the overall sample and then in subgroups of frail and pre-frail subjects according to the frailty phenotype. Optimal cut-off points were determined to obtain the best sensitivity/specificity ratio and the highest number of correctly classified subjects.
Among 267 patients, mean age=81.5±5.8; women=67.0%; 138 (51.7%) were frail, 98 (36.7%) were pre-frail and 31 (11.6%) were robust. Given their MNA-SF scores, 201 (75.3%) had a good nutritional status, 61 (22.8%) were at risk of malnutrition and 5 (1.9%) were malnourished. In the overall sample, but also in subgroups of pre-frail or frail elders, the areas under ROC curves were 0.954, 0.948 and 0.958 respectively. The 11 points cut-off provided the best correct classification ratio (91.4%); sensitivity=94.0%, specificity=83.3%.
The MNA-SF appeared to be a validated and effective tool for malnutrition screening in frail elders. Implementing this tool in clinical routine should contribute to improving the screening of malnourished frail individuals.
It has been in the early nineties when Bruno Vellas, Yves Guigoz and Philipp J. Gary developed the Mini Nutritional Assessment in a successful transatlantic research cooperation. It was their aim to provide geriatricians and all those that are professionally involved in the care of older individuals with a validated, but also practical tool for the nutritional screening of this at risk population. Since then hundreds of scientific papers have been published that included the MNA as a diagnostic standard for malnutrition in older persons. Even more important the MNA has gained wide acceptance as an officially recognised nutritional screening tool. For example after the 2011 Japan earthquake the MNA®- SF was used in evacuation centres to quickly and easily evaluate the nutritional status in vulnerable older adults. It may also be regarded as proof of the MNA's worldwide acceptance and significance that papers from four continents - Europe, America, Asia and Australia - have been included in this special issue of the JNHA. The first section of this special issue includes several papers that provide us with new insight on the prevalence and the relevance of malnutrition in important geriatric subpopulations like those admitted to the emergency department, those attending dementia clincs, those affected by systolic heart failure, those with diabetes and those beyond age 90. For example, Roqué et al. describe a higher prevalence of malnutrition in dementia with Lewy bodies than in other forms of dementia. In addition their paper offers profound information on potential etiological factors for malnutrition in patients with dementia. The study by Sargento et al. documents the high prognostic relevance of malnutrition in a population of geriatric outpatients with systolic heart failure. Kuyumcu et al. describe for the first time the nutritional status of Turkish nursing home residents based on the MNA and document its relevance for the prediction of short-term mortality. Finally Jane Winter et al. observed that even among well-aging older adults in the community a relevant number will be at risk of malnutrition and that many of them will be found among those with BMI above 25 kg/m2. Good things could sometimes still be made better. With regard to the MNA the desire to improve its practicability led to the development of the MNA Short Form, which in its original version from 2001 presented only two categories, "well-nourished" and "at risk". At that time the use of the MNA-SF was still considered as a two-step procedure, which would include the completion of the full MNA in those classified at risk. With regard to the ongoing limitation of resources and with the clear aim to allow screening in a larger proportion of the older population a revised version of the MNA-SF was published in 2009. The revised MNA-SF offers three results categories, which are identical to the original MNA. In addition if BMI is not available it can be substituted by calf circumference. The validity of this approach has recently been validated for a Spanish nursing home population by Garcia-Meseguer et al. In this special issue you find two papers that go even further with regard to MNA applicability. On the one hand it is Donini et al. that provide data on two new MNA versions that do without the BMI. Second Huhmann et al. tested a self-completed MNA which might offer an option to spread nutritional screening dramatically beyond the present boundaries induced mainly by scarce professional resources. However, other researchers have to verify whether this approach is in fact feasible. Diekmann et al. compared the MNA with other established nutritional screening tools like the NRS (Nutritional Risk Screening) and the MUST (Malnutrition Universal Screening Tool) with regard to applicability and prognostic value in the nursing home setting. What we really care about in older persons is their functionality and their quality of life. Our main focus should not be the improvement of rather abstract nutritional parameters like weight, calf circumference or body composition. Those are definitely important from a scientific point of view but in most instances we will have to relate nutrition to function if we want to claim relevance. However, nutrition and functionality constitute a bidirectional relationship as one strongly influences the other. Therefore it has to be welcomed that three papers in this special issue focus on the links between the MNA and function. Frailty, mainly referred to as physical frailty and characterized by increased vulnerability as a consequence of multisystem dysregulation, is regarded as a highly relevant geriatric syndrome that is just about to enter clinical routine. Bollwein et al. analysed the relationship between MNA and frailty in community living older persons. Stange et al. focus on the relationship between nutrition and functionality in a large population of nursing home residents, while Kiesswetter et al. illustrate this aspect in older adults receiving home care. Little information has been available in this regard before. The last section of this special issue includes two papers that may be seen as examples for thinking outside the box. Muzembo et al. point toward a potential relationship between malnutrition and peripheral arterial disease, while Charlton provides interesting information on the apperception of supplements among community living older individuals. While I am confident that the diversity of the articles that have been included in this special issue will stimulate future research in the context of the MNA my true expectations go beyond that. All those who devote significant time and effort to the nutritional needs of the older population should strive to have the MNA routinely included in their evaluation, independent of the setting they are living in. However, we must not forget that the MNA has to be regarded only as a first step in the nutritional management of older persons, as it should be followed by individual assessment in those that have been categorized as malnourished. Concerning public awareness of malnutrition in older persons some important steps forward have been realized in many countries in recent years, but we have to be cautious that we won't fall back again, especially under the strong economic pressure many of us face today. Complacency in this regard is therefore not indicated. However, the wide accceptance of the MNA among experts which is based on its usefulness and its reliability will help us to take a clear stand towards the nutritional needs of the older population and the use of MNA will thereby support the interests of our patients.
Bibliometry is a widely used method assessing the activity of research.
Assess research activity of the French geriatric teams by bibliometry for the last 22 years and replaced it in the evolution of the French geriatrics.
Data were collected via MEDLINE through Internet PubMed. Publications from French geriatrics teams were identified using search of relevant terms for geriatrics in the field Affiliation from 1985 to 2006. Citations and abstracts were analyzed before including the publication in the study.
We identified 692 articles published by French geriatric teams. Among them, 295 were English articles and 166 were reviews of the literature. Throughout these twenty-two years, the number of publications was consequentially increased. Nutrition and dementia-psychogeriatrics were the themes most often mentioned. The total of these publications impact factors (IF) is 753 points over the last twenty-two years, rating from 45 points between 1985 and 1989 to 330 points between 2000 and 2004. The mean score of the impact factors by publication remains relatively stable, but the number of publications having an impact factor superior to 3 increases in the course of this time interval.
This bibliometric investigation points out the growing interest of the French geriatrics in clinical research, mostly oriented toward nutrition and dementia in the elderly.
Energy intake patterns that may impact health status among non-affluent southern U.S. women from small urban communities have not been evaluated extensively. Usual intake estimates are confounded by factors such as validity of intake methods and socioeconomic status. Typical 24-h energy intakes were reported by Caucasian (CA, n=149) and African-American (AA, n=110) women; at 43% of this sub-population, AA women are appropriately and proportionately represented. Daily energy intake was examined for these non-pregnant females, 24 to 93 y of age, to define typical energy, carbohydrate, protein, and fat intake. Study groups were: 24-29 y, 30-39 y, 40-49 y, 50-59 y, 60-69 y, 70-79 y, and 80-93 y. Statistical comparisons of nutrient variables by age were made by least squares means between groups. Body mass index (BMI) calculations accounted for differences in height and relative body mass. Both races reported similar energy intakes and significant (P<0.05) decreases with age were noted. Energy intakes were 15-40% below recommended levels, similar to reported values; senior lunch programs ameliorated declines among some women >60 y. More daily calories (52-62%) were provided by carbohydrates, followed by fat (26-35%) and protein (14-17%) findings in close agreement with health recommendations. Time-of-day intake patterns suggest women >59 y consume larger noon meals. BMI for AA women was greater (P<0.05) than that of CA women between 30-59 y. At 24-29 y, AA women had lowest BMI values; BMI decreases occurred in CA women after 80 y. These factors may impact the health of non-affluent southern AA and CA women, particularly the elderly who may require guidance for diet planning and intake intervention programs.
To examine the reproducibility of 24-hour dietary recall for estimating dietary vitamin intakes by middle-aged Japanese men and women.
The subjects were 132 men and 130 women aged 40-69 years, selected from participants in cardiovascular risk surveys conducted in 4 communities. The reproducibility of the 24-hour dietary recall was tested by comparing nutrient and food intake for two recalls conducted on the same season 1 year apart, designated as recalls 1 and 2. Differences in mean values between two recalls were tested using analysis of variance, and Spearman rank correlation coefficients for the two recalls were calculated for nutrient and food intakes. Mean values of energy and vitamins for both sexes were generally similar for the two recalls. The reproducibility of recall by men was high for vitamin B2, folate, pantothenic acid, and vitamin C and by women for vitamin B2, moderate by men for vitamins A, E, K, B1, B6 and niacin, and by women for vitamins A, E, K, B1, B6 and niacin, folate, pantothenic acid and vitamin C, and low by both men and women for vitamins D and B12. The reproducibility during 1985-1999 was generally lower than that of 1973-1984, but that for folate, pantothenic acid and vitamin C remained to be moderate in 1984-1999.
Although the reproducibility of 24-hour dietary recall varies among vitamins, moderate and sustained reproducibility was observed for folate, vitamin C and pantothenic acid.
Estimation of Stature by Measuring Fibula and Ulna Bone Length in 2443 Older Adults.
Knee height has been commonly used to estimate stature but may not always be possible in the frail older adults with compromised posture. Measurement of fibula and ulna bone length could be an alternative method. We attempted to develop and validate regression models to predict measured and reported height using age, fibula length, ulna length, hip circumferences and body weight.
A cross-sectional survey.
The study was conducted in the Jockey Club Centre for Osteoporosis Care and Control, School of Public Health, The Chinese University of Hong Kong.
Two thousand four hundred and forty three community-dwelling older Chinese aged from 65 to 98 years were recruited.
The standing height, fibula length, ulna length, hip circumference and body weight were measured and the reported height was recorded. Three separate multiple linear regression models were developed to predict measured-height and reported-height respectively.
In predicting measured-height by the bone-length model, the mean errors were +0.52 cm (over-estimation) in men and +0.45 cm (over-estimation) in women and the SDs were +/- 3.5 cm in both genders. The 95% limits of agreement were: -6.65 to +7.70 cm for men and -6.59 to +7.49 cm for women.
The accuracy and precision of stature estimation by fibula and ulna bone length is comparable to that by knee height. This may be an acceptable alternative method when knee height measurement is difficult or when the knee height caliper is not available.
Studies on Alzheimer's disease (AD) revealed that cholesterol metabolism might be involved in the pathogenesis of this neurodegenerative disorder. The apolipoprotein E4 genotype is a known risk factor in AD. Elevated serum cholesterol concentrations are detected in patients with AD and two recent epidemiological studies have indicated that treatment with inhibitors of cholesterol synthesis (statins) decrease the incidence of AD. 24R- and 24S-hydroxycholesterol, the major cholesterol elimination product of the brain, possess neurotoxic effects in vitro, and increased concentrations of 24S-hydroxycholesterol have been detected in patients from our department, suggesting a role for this oxysterol in the pathogenesis of AD. This review will give a brief overview on the relevance of 24S-hydroxycholesterol as a possible risk factor and diagnostic state marker for AD.
To examine the association between baseline frailty measurements and cognitive function 4 years later.
Prospective observational study.
Two thousand seven hundred and thirty seven cognitively normal older adults.
The appendicular muscle mass (ASM), hand grip strength, timed chair-stand test, walking speed and step length were measured at baseline. The Mini-mental state examination (MMSE) was administered at baseline and 4 years later.
In men, all baseline frailty measurements, namely, being underweight, lower ASM, weaker grip strength, slower chair-stand test, shorter step length, slower timed walk were significantly associated with a lower MMSE score 4 years afterwards. After adjustment for age, years of education and baseline MMSE score, ASM and timed walk became insignificant. In women, all frailty measurements except underweight and low ASM were significantly associated with MMSE score 4 years later. Moreover, only weaker grip strength persisted to be significant after adjustment for age, years of education and baseline MMSE score.
Physical frailty, as represented by being underweight, weaker grip strength, slower chair-stand test, shorter step-length in men and weaker grip strength in women, was associated with cognitive decline over a four year period.
This study was conducted to assess the validity and the reliability of simple tools to screen the protein-energy malnutrition (PEM) risk among the elderly population in healthcare facilities. An initial screening tool, made up of nine PEM risk factors, was previously developed to be validated. This tool was quite complex and showed low validity results. A stepwise regression analysis determined significant risk factors (P < or = 0.05) among those included in the initial tool. These were the foundation to develop two simplified screening tools. One included Body Mass Index (BMI) and % weight loss over time. The second included BMI and albumin. Both tools classified subjects in low or high PEM risk levels. In the present study, the simple tools were assessed in a sample of 142 elderly subjects divided into two categories: acute care elderly (ACE, n=72) and long-term care elderly (LTCE, n=70). The simple tools were administered by a dietetic technician and a nurse with the purpose of assessing inter-rater and test-retest reliabilities. The criterion validity of the simple tools were assessed in comparison to in-depth nutritional assessments carried out by a dietitian. The validity results were ranked between 60.5% and 91.7%. The reliability scores showed levels of agreement of 70.8% to 93.1% and kappa coefficients ranking between 0.59(+/-0.07) and 0.79(+/-0.05). Simple tools are now available for efficiently screening the PEM risk among the elderly population on a healthcare facility-wide basis.
To explore the association of frailty according to questionnaire data (modified Fried criteria) with important endpoints in older men.
Prospective cohort study (the Helsinki Businessmen Study) in Finland.
In 1974, clinically healthy men (born 1919-1934, n=1815) of similar socioeconomic status were identified. After a 26-year follow-up in 2000 (mean age 73 years), disease prevalence, mobility-disability, and frailty status (80.9% of survivors, n=1125) were appraised using a postal questionnaire including RAND-36. Four criteria were used for definition: 1) >5% weight loss from midlife, or body mass index (BMI) <21 kg/m2; 2) reported physical inactivity; 3) low vitality (RAND-36); 4) physical weakness (RAND-36). Responders with 3-4, 1-2, and zero criteria were classified as frail (n=108), prefrail (n=567), and nonfrail (n=450), respectively. Eight-year mortality was assessed from registers, and in 2007, survivors were re-assessed with questionnaires.
Nonfrail as referent and adjusted for age, BMI and smoking, both prefrail (HR 2.26; 95% CI, 1.57-3.26), and frail status (4.09; 95% CI, 2.60-6.44) were significant predictors of mortality. Nonfrailty predicted better survival independently of the frailty components, diseases, and disability, and also predicted faster walking speed and less disability 7 years later.
Frailty, and also prefrailty, as defined using questionnaire data (RAND-36) independently predicted important endpoints in older men.
Within a larger study of social network and nutrition, we investigated measurements of nutritional status and health related quality of life.
To relate a well-established questionnaire of nutritional status (MNA) to a likewise well-established questionnaire of health related quality of life (SF-36) in community dwelling, free-living and, healthy 70-75 years old persons.
Before an interview, the MNA and SF-36 questionnaires were filled in by 128 participants from a sample of 262 subjects.
The MNA worked well as a measurement in this sample. Many MNA aspects correlated with the SF-36 scales. The correlations between MNA total score and the eight SF-36 scales varied from .27 to .62.
This correlation was partly due to the fact that MNA has questions of health but also to the fact that there is an empirical relation between nutrition and health. Conclusion: The MNA measurement is applicable to a healthy, free-living elderly population and parts of the MNA can be interpreted as measurements of health related quality of life. Low values of SF-36 could also be used as predictors of risk of malnutrition, although further studies are required to confirm this result.
Mobility disability is a major problem in older people. Numerous scales exist for the measurement of disability but often these do not permit comparisons between study groups. The physical functioning (PF) domain of the established and widely used Short Form-36 (SF-36) questionnaire asks about limitations on ten mobility activities.
To describe prevalence of mobility disability in an elderly population, investigate the validity of the SF-36 PF score as a measure of mobility disability, and to establish age and sex specific norms for the PF score.
We explored relationships between the SF-36 PF score and objectively measured physical performance variables among 349 men and 280 women, 59-72 years of age, who participated in the Hertfordshire Cohort Study (HCS). Normative data were derived from the Health Survey for England (HSE) 1996.
32% of men and 46% of women had at least some limitation in PF scale items. Poor SF-36 PF scores (lowest fifth of the gender-specific distribution) were related to: lower grip strength; longer timed-up-and-go, 3m walk, and chair rises test times in men and women; and lower quadriceps peak torque in women but not men. HSE normative data showed that median PF scores declined with increasing age in men and women.
Our results are consistent with the SF-36 PF score being a valid measure of mobility disability in epidemiological studies. This approach might be a first step towards enabling simple comparisons of prevalence of mobility disability between different studies of older people. The SF-36 PF score could usefully complement existing detailed schemes for classification of disability and it now requires validation against them.
The objective of our study was to compare advantages and limitations of two generic Quality of Life questionnaires administered in older inpatients.
Two validated generic health-related Quality of Life instruments : the MOS Short-Form 36 (9 dimensions, 36 items) and the Duke Health Profile (6 dimensions, 4 dysfunctions, 17 items) were administered to inpatients over 65 years.
The sample was drawn from the CliniQualVie program that assessed systematically Quality of Life among hospitalized inpatients (18-79 years) in 10 medical and surgical wards at Nancy University Hospital.
The two self-administered questionnaires were completed by 701 patients over 65 years at admission (mean age 71 +/- 4, 63% men). The proportion of patients who completed all items were 72.5% for the Duke and 66.9% for the SF-36 (p < .001). The Duke's internal consistency was low as compared with the SF-36, but other psychometric properties were comparable. Good correlations (Spearman) were observed between the two questionnaires for physical health (0.59, p < .0001), mental health (0.68, p < .0001) and health perception (0.56, p < .0001) scores. Low correlations were observed for the social score.
This is the first study to our knowledge to assess the interest of using the Duke Health Profile in a general elderly inpatients population as compared with the SF-36 questionnaire. Although these two questionnaires have four comparable dimensions, they differ in their content and psychometric properties. The Duke questionnaire, due to its better completion rate and despite some psychometric limitations may be useful in this population, particularly in the more frail patients.
Diet plays an important role in maintaining quality of life in ageing and can be influenced by sociodemographic factors. We aimed to describe dietary habits in a large population-based sample of elderly people and to explore how they may vary according to sex, age, educational level and lifestyle.
9250 community dwellers aged 65 years and over recruited in three French cities were interviewed about their food habits with a brief frequency questionnaire. For each food considered, the subjects were classified as occasional or regular consumers. Quantities of alcoholic beverages consumed daily were also assessed. Dietary habits were compared for men and women separately according each sociodemographic factor.
Women were characterized by a more regular consumption of fruit and vegetables and drunk fewer alcoholic beverages. Older subjects ate meat, fish, cereals, raw vegetables and pulses less regularly. The proportion of regular consumers of fish, raw fruit, raw vegetables and cooked fruit or vegetables and the quantity of alcohol consumed increased with educational level. Subjects living alone were less regular consumers of almost all foods.
The results show that even in a sub-population of elderly people, dietary patterns can vary greatly according to several factors. Identifying such factors is of value for future analytic studies on nutrition and health in the elderly. In view of dietary recommendations advising a high consumption of fruit and vegetables, subjects living alone and people with a low educational level are particularly at risk and should be encouraged to eat more balanced meals.
In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy.
Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation.
Geriatric clinic at an academic teaching hospital in Hamburg, Germany.
4,735 hospitalised patients ≥65 years.
Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated.
There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items 'transfer' + 'walking' score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3.
Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.
In this study, the influence of in vivo lipid peroxidation (LPO) on cytochrome P-450 (P-450) degradation was investigated using rat liver microsomes. To identify the nature of P-450 degradation, three different perturbant LPO-initiation systems were employed: NADPH/ADP-Fe, cumene hydroperoxide (CHP), and 2,2'-azobis (2-amidino- propane) hydrochloride (AAPH). The results show that each of these systems readily induced P-450 degradation during in vitro LPO and that the progression and extent of the degradation increased with incubation time. However, attempts to elicit P-450 degradation by the use of hydrogen peroxide, superoxide, or hexanal failed to induce damage. Interestingly, the addition of several well-known radical scavengers and radical scavenging enzymes, including superoxide dismutase and catalase, into the incubation media provided little protection against P-450 degradation or malondialdehyde (MDA) formation. It was found, however, that sulfhydryl compounds, including GSH and substrates of P-450-dependent monooxygenases, provided varying degrees of protection. Based on the specificity of protective action, it was concluded that the structural stability of P-450 to defend against LPO requires reduced thiols and/or substrate binding. This suggests that P-450 degradation by LPO is closely related to the oxidation of certain essential thiol groups located at the substrate binding site of the P-450 molecule during LPO reaction.
Creatine and whey protein are supplements believed to have an ergogenic effect. Very little is known regarding the effects of these dietary supplements in older men. The purpose of this study was to determine the effect of creatine and whey protein supplements, consumed independently and in combination, on total and regional body composition in middle-aged men during a resistance-training program.
Forty-two men were randomly assigned to four groups to receive supplements according to a double-blind protocol. Groups consumed their supplements three times per week immediately following their resistance training sessions. The groups were: 1) placebo (480 ml of Gatorade); 2) creatine (480 ml of Gatorade plus 5 grams of creatine); 3) whey protein (480 ml of Gatorade plus 35 grams of whey protein powder); and 4) whey protein/creatine (480 ml of Gatorade plus 5 grams of creatine and 35 grams of whey protein powder). All groups participated in resistance training 3 times per week for 14 weeks.
At the beginning and end of the study, total and regional measures of body composition (DXA) and total (TBW), intracellular (ICW), and extracellular (ECW) body water (Multifrequency BIA) were measured and 3-day diet records were completed. Results: There were significant training effects for regional arm fat (decrease), regional arm bone free-fat free mass (BF-FFM - increase), total body BF-FFM (increase), ICW (increase), and ECW (increase) but no significant group effects and only one significant group by training interaction (ECW). There were no significant changes for total calorie, carbohydrate, fat or protein intake for any of the groups from prestudy to post-study testing.
The results from this study suggest that supplementation with creatine, whey protein, or a combination of creatine and whey protein, when combined with resistance training in middle-aged men, have no added benefit to changes that occur to body composition due to resistance training alone.
Studies in Swedish nursing-home patients have shown a high prevalence of protein-energy malnutrition. One potential cause for this may be low food intake.
To examine the intake of energy and nutrients in the residents of a nursing home; to investigate changes in dietary intake and body-weight over time and to analyze two-year-mortality.
Explorative study. Five-day weighed assessment of food intake repeated three times during 1.5 years. Analysis of body composition at baseline and recording of body weight every third month. Analysis of two-year mortality.
Fifty-two residents had three complete dietary assessments. Mean age 84 +/- 7 years, 79% were female. Mean body weight was stable at 61 kg. Mean energy intake at baseline was 1501 kcal/d (25 kcal/kg/d) and mean protein intake was 53 g/d (0.9 g/kg/d). Mean intake of vitamin D, vitamin E, folic acid, selenium and dietary fibre was less than 60% of recommended. At the second assessment intake of energy and many nutrients was higher than at baseline, but at the third assessment intake had decreased. There was no correlation between energy intake and body weight over time. Two-year mortality was 52%. Male gender and low body-weight constituted an increased risk of mortality. Comparing survivors and non-survivors showed that the mean body weight was 9 kg higher in the survivors throughout the study (p=0.02). This group had a relatively lower fat free mass and higher fat mass than the non-survivors. The difference in body composition was only seen in females, possibly due to the low number of males. The survivors had higher intakes of most nutrients but this reached significance only for a few of them. The non-survivors had significantly higher intakes of sucrose.
Intake of energy and many nutrients was low in these nursing-home patients, and decreased further after one year, without any change in body weight. The significant positive relation between energy intake and body weight at group level disappeared when analyzing data at an individual level. Male gender and low body weight were associated with increased risk of mortality.
Epidemiological studies of aging are usually confronted with the presence of numerous pathologies or environmental factors which make it difficult to identify the effects of aging individually. One way of reducing the variability among individuals is to use well defined criteria to select the study population. This is the choice that was made for the New Mexico and Toulouse Aging Process Studies, which were particularly turned towards successful aging. In this study we have sought to explain the diversity of states of health of the subjects of these two studies by means of an aging classification exploring the medical history, balance and walking, and the cognitive functions. This reveals that the poorer health of certain subjects (about 10% and 30% of the populations of Toulouse and Albuquerque respectively) is slightly associated with changes in eating behaviour relative to subjects who age successfully. We have, however observed a decrease in vitamin E intake in Toulouse associated with a reduction of lipids in the food. But the poorer state of health is predominantly explained by advancing age and the occurrence of pathological states. This study confirms that aging was generally successful in the two populations studied.
Examination of the individual intake of energy, nutrients and water in clinically stable multidiseased nursing-home residents.
Comprehensive clinical assessment of 54 elderly nursing-home residents (80 +/- 10 years, mean +/- SD). The intake of food and beverages was measured by the weighed food intake method during five consecutive week days followed by computerized transformation to energy, 21 different nutrients, dietary fiber, alcohol and water. The resting energy expenditure was determined by indirect calorimetry.
There was at least 2-3-fold, variation in intake of energy, nutrients and water, present also when expressed per kg body weight. For some micronutrients the relative intake variation was more than 8-fold. The results are compared with the present swedish recommended dietary allowances as well as with seven other studies of dietary intake in elderly using the weighed food intake method. The residents had on average 14.1 (range 6-31) different current clinical problems and were treated with a mean of 9.5 different drugs. The nursing staff spent 40 % of the total daytime working hours (7 am to 7 pm) on nutrition related issues.
The nursing-home residents exhibited a large interindividual heterogeneity regarding intake of energy, nutrients and water. More emphasis should be given to individualized nutrition assessment in clinical geriatric care as a more solid base for nutrition treatment programmes integrated with the regular medical management and evaluation.
Sociodemographic, lifestyle and dietary characteristics were studied to gain insights into determinants of total diet quality and diversity in a weighted sample of 460 participants aged 55-74 (53% female) from the 1990 Enqu te qu b coise sur la nutrition (EQN) dataset.
Dietary data consisted of an interviewer-administered 24-hour recall and food frequency questionnaire, and a self-administered questionnaire on dietary behaviours, attitudes and perceptions. 24-hour recall data were coded into food groups as described in Canada's Food Guide for Healthy Eating. Diet quality was scored using the categorical Dietary Diversity Score (DDS, range 0-4) and continuous Dietary Adequacy Score (DAS, range 0-18). A second nonconsecutive recall (10% of subjects) permitted correction of food group portions for intraindividual variability and subsequent calculation and validation of usual DDS and DAS. Relationships were examined between the scores and independent variables. Forward leastwise logistic regession (DDS) and stepwise multiple regression (DAS) analyses were conducted with independent variables showing significant bivariate relationships.
Among men, breakfast consumption and eating commercially-prepared meals were positively associated with usual DDS, but poor social support and supplement use negatively predicted this score. Eating fewer than 3 meals daily, smoking, and dietary supplement use were negative predictors of usual DAS (r2=0.155). Among women, eating commercial foods was a negative predictor of usual DDS, as was preferring overweight to depriving themselves of favourite foods. Reporting that health concerns influenced food choices and disagreeing with the statement that effort is needed to have a nice body were positive determinants of usual DAS in women. On the other hand, eating fewer than 3 meals daily negatively predicted this dietary index (r2 = 0.162).
Gender differences in predictors of diet quality suggest the need to target nutrition health promotion to the needs of older men and women to encourage optimal eating habits.